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JP2004320771A - Method for performing digital subtraction angiography - Google Patents

Method for performing digital subtraction angiography Download PDF

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JP2004320771A
JP2004320771A JP2004117627A JP2004117627A JP2004320771A JP 2004320771 A JP2004320771 A JP 2004320771A JP 2004117627 A JP2004117627 A JP 2004117627A JP 2004117627 A JP2004117627 A JP 2004117627A JP 2004320771 A JP2004320771 A JP 2004320771A
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Joachim Hornegger
ヨアヒム　ホルネッガー
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Abstract

<P>PROBLEM TO BE SOLVED: To perform a digital subtraction angiography so as to reduce the X-ray amount applied to a patient required for subtraction angiography from a long-term view. <P>SOLUTION: A method is provided for performing digital subtraction angiography, to generate an image of a structure (particularly blood vessel) of a body range, by performing subtraction between the image data of a first two-dimensional X-ray image of the body range, which is generated in a state without contrast medium dosed to a structure, and the image data of a second two-dimensional X-ray image of the body range, which is photographed in a state of the contrast medium dosed to the structure. In this method, the image data of the first two-dimensional X-ray image are calculated from a three-dimensional volume data set of a computed tomography of the body range. <P>COPYRIGHT: (C)2005,JPO&NCIPI

Description

本発明は、本来存在するボリュームデータセットを用いてディジタルサブトラクション血管造影法を実施するための方法、特に、構造物へ造影剤を投与されない状態で作成された身体範囲の第１の２次元Ｘ線画像の画像データと、構造物へ造影剤を投与された状態で撮影された身体範囲の第２の２次元Ｘ線画像の画像データとの減算によって身体範囲の構造物（特に血管）の画像を形成するディジタルサブトラクション血管造影法（ＤＳＡ、ディジタルサブトラクションアンギオグラフィ）を実施するための方法に関する。   The present invention relates to a method for performing digital subtraction angiography using an intrinsically existing volume data set, and in particular to a first two-dimensional x-ray of a body area created without administration of a contrast agent to a structure. By subtracting the image data of the image and the image data of the second two-dimensional X-ray image of the body region captured in a state where the contrast agent is applied to the structure, an image of the structure (particularly, blood vessel) in the body region is obtained. The present invention relates to a method for performing digital subtraction angiography (DSA, digital subtraction angiography).

サブトラクション血管造影法は、例えば血管収縮（狭窄症）または血管拡張（動脈瘤）のような起こり得る血管異常を画像から認識するために人体の血管を画像表示するのに使用される。Ｘ線画像における血管の可視度を改善するために、Ｘ線撮影前に血液に造影剤が投与されるので、Ｘ線画像における血管は明らかに背景から際立って見える。しかしながら、血管のほかに、一般に、画像内で血管を部分的に覆い隠すことのある例えば骨などの他の構造物または対象物がＸ線画像に見える。この問題点を回避するためにサブトラクション血管造影法の技術が使用される。サブトラクション血管造影法では、同一身体範囲の同一投影方向における２つのディジタルＸ線撮影が描画される。両撮影の一方、すなわち所謂マスク像は造影剤なしで実施され、他方の撮影、所謂ライブ像は造影剤を用いて実施される。Ｘ線検出器の対数計算された測定値から得られる両撮影のディジタル画像データの減算によって、撮影における同一の解剖学上の背景は消えるので、純粋な血管画像が生じる。この血管画像では、例えば骨のような対象物の前方または後方における血管でさえグレイ値の跳躍なしに表示される（例えば非特許文献１参照）。   Subtraction angiography is used to image human blood vessels to recognize possible vascular abnormalities from the image, such as vasoconstriction (stenosis) or vasodilation (aneurysm). The blood vessels in the X-ray image are clearly visible from the background because a contrast agent is administered to the blood before the X-ray to improve the visibility of the blood vessels in the X-ray image. However, in addition to blood vessels, other structures or objects, such as bones, that may partially obscure the blood vessels in the image, are generally visible in the x-ray image. To avoid this problem, the technique of subtraction angiography is used. In subtraction angiography, two digital radiographs of the same body area in the same projection direction are drawn. One of the two scans, a so-called mask image, is performed without a contrast agent, and the other scan, a so-called live image, is performed with a contrast agent. Subtraction of the digital image data of both scans obtained from the logarithmically calculated measurements of the X-ray detector results in a pure blood vessel image, since the same anatomical background in the scans disappears. In this blood vessel image, even a blood vessel in front or behind an object such as a bone is displayed without a gray value jump (for example, see Non-Patent Document 1).

しかしながら、この公知の技術の欠点は、従来、サブトラクション血管造影法を実施するためには、ライブ撮影およびマスク撮影という２つのＸ線撮影が行なわれなければならないことにある。これらの撮影は、しばしば定期的に必要な監視検査の都度、新たになされなければならない。
“Ｉｍａｇｉｎｇ Ｓｙｓｔｅｍ ｆｏｒ Ｍｅｄｉｃａｌ Ｄｉａｇｎｏｓｔｉｃｓ”，ｅｄ．：Ｅｒｉｃｈ Ｋｒｅｓｔｅｌ，Ｓｉｅｍｅｎｓ Ａｋｔｉｅｎｇｅｓｅｌｌｓｃｈａｆｔ，Ｂｅｒｌｉｎ ａｎｄ Ｍｕｎｉｃｈ，１９９０，ｐｐ．３６９〜３７４ However, a disadvantage of this known technique is that conventionally, two X-rays, live imaging and mask imaging, have to be performed in order to carry out subtraction angiography. These scans often have to be renewed for each required surveillance test.
"Imaging System for Medical Diagnostics", ed. : Erich Krestel, Siemens Aktiengesellschaft, Berlin and Munich, 1990, pp. 369-374

本発明の課題は、サブトラクション血管造影法に必要な患者へのＸ線量が長期的に見て低減されるようにディジタルサブトラクション血管造影法を実施することにある。   It is an object of the present invention to implement digital subtraction angiography so that the X-ray dose to the patient required for subtraction angiography is reduced in the long run.

この課題は、構造物へ造影剤を投与されない状態で作成された身体範囲の第１の２次元Ｘ線画像の画像データと、構造物へ造影剤を投与された状態で撮影された身体範囲の第２の２次元Ｘ線画像の画像データとの減算によって身体範囲の構造物（特に血管）の画像を形成するディジタルサブトラクション血管造影法を実施するための方法において、第１の２次元Ｘ線画像の画像データが身体範囲のコンピュータ断層撮影の３次元ボリュームデータセットから算出されることによって解決される。この方法の有利な実施態様は従属請求項の対象であり、以下の説明並びに実施例から導き出される。   The object is to provide image data of a first two-dimensional X-ray image of a body region created in a state where a contrast agent is not administered to a structure, and a body region captured in a state where a contrast agent is administered to a structure. A method for performing digital subtraction angiography for forming an image of a structure (particularly a blood vessel) in a body region by subtraction from image data of a second two-dimensional X-ray image, the method comprising: Is calculated from a computed tomographic three-dimensional volume data set of the body area. Advantageous embodiments of the method are the subject of the dependent claims and are derived from the following description and examples.

本発明による方法では、患者の多くには既にＸ線コンピュータ断層撮影、とりわけＣアーム形コンピュータ断層撮影装置から得られた３次元ボリュームデータセットが存在することが利用される。Ｘ線コンピュータ断層撮影法は、横断層画像（すなわち身体軸線に対してほぼ垂直に向けられた身体断層の画像）が得られる特殊なＸ線断層撮影法である。このために、検査ボリュームは多数の角度で層をなして照射されるので、３次元ボリュームデータセットが得られる。これらの３次元ボリュームデータセットから、適切な投影法によって２次元Ｘ線撮影または写実的な２次元画像が算出される。この種の画像のほかに、コンピュータ断層撮影法により３次元ボリュームデータから、他の画像表示、例えば検査ボリューム内の対象物の表面構造の画像表示も算出される。   The method according to the invention makes use of the fact that many patients already have X-ray computed tomography, in particular a three-dimensional volume data set obtained from a C-arm computed tomography apparatus. X-ray computed tomography is a special type of X-ray tomography in which a transverse layer image (ie, an image of a body tomogram oriented substantially perpendicular to the body axis) is obtained. For this, the examination volume is illuminated in layers at a number of angles, so that a three-dimensional volume data set is obtained. From these three-dimensional volume data sets, two-dimensional radiography or a realistic two-dimensional image is calculated by an appropriate projection method. In addition to this type of image, another image display, for example, an image display of the surface structure of the object in the inspection volume, is calculated from the three-dimensional volume data by computer tomography.

本発明による方法の場合、造影剤を投与された状態での身体範囲の画像データすなわちライブ像を得るために、患者の身体範囲の従来の２次元Ｘ線撮影は、表示すべき構造物への造影剤投与後になされる。造影剤を投与されない状態での同一身体範囲の画像データは、もちろん別の２次元Ｘ線撮影を介してではなくて、本発明による方法では既に存在する３次元ボリュームデータから算出される。これらの３次元ボリュームデータは、検出された身体範囲の各ボリュームエレメント（ボクセル）について、造影剤を投与されない状態でのこのボクセルのＸ線透過率を表わす密度値を含んでいる。３次元ボリュームデータからの２次元画像データの算出はＸ線吸収原理を用いて公知のように行なわれる。このＸ線吸収原理では、与えられた投影方向での身体範囲透過時にＸ線画像として得られる密度分布が計算される。これは、例えば「Ｈ．Ｓｃｈｕｍａｎｎ，Ｗ．Ｍｕｅｌｌｅｒ共著、“Ｖｉｓｕａｌｉｓｉｅｒｕｎｇ．Ｇｒｕｎｄｌａｇｅｎ ｕｎｄ ａｌｌｇｅｍｅｉｎｅ ｍｅｔｈｏｄｅｎ"，Ｓｐｒｉｎｇｅｒ Ｖｅｒｌａｇ，Ｂｅｒｌｉｎ，２０００年，第２５１〜３０６頁」に記載されている。この場合、伝達関数およびαブレンディング（アルファ−ブレンディング）が適切にパラメータ設定される。このようにしてマスク像が得られる。このマスク像は、表示すべき構造物の画像を得るために、公知のようにライブ像から減算することができる。   In the case of the method according to the invention, a conventional two-dimensional radiography of the patient's body area to obtain image data, ie a live image, of the body area with the contrast agent being applied, requires that the structure to be displayed be exposed to the structure to be displayed. This is done after administration of the contrast agent. The image data of the same body area without the administration of the contrast agent is, of course, calculated from the already existing three-dimensional volume data in the method according to the invention, not via another two-dimensional radiography. These three-dimensional volume data include, for each volume element (voxel) of the detected body area, a density value representing the X-ray transmittance of this voxel in a state where no contrast agent is administered. Calculation of the two-dimensional image data from the three-dimensional volume data is performed in a known manner using the X-ray absorption principle. According to the X-ray absorption principle, a density distribution obtained as an X-ray image when transmitted through a body range in a given projection direction is calculated. This is described, for example, in "Visalisierung. H. Schummann, W. Mueller". Grundlagen und allgemeine method ", Springer Verlag, Berlin, 2000, pp. 251 to 306". In this case, the transfer function and α blending (alpha-blending) are appropriately parameterized. Thus, a mask image is obtained. This mask image can be subtracted from the live image in a known manner in order to obtain an image of the structure to be displayed.

マスク像の算出時の正確な投影方向は、３次元ボリュームデータセットへのライブ像用の２次元撮影の登録、すなわち座標系の空間的相関関係の作成を介して確保されるので、ライブ像およびマスク像が同一投影方向で得られる。医用画像データの登録のための適切な方法は当業者に知られている。   The accurate projection direction when calculating the mask image is ensured through registration of the two-dimensional imaging for the live image in the three-dimensional volume data set, that is, creation of the spatial correlation of the coordinate system. Mask images are obtained in the same projection direction. Suitable methods for registration of medical image data are known to those skilled in the art.

それゆえ、本発明による方法により、血管または造影剤を投与可能な他の構造物がサブトラクション血管造影法により表示される患者の各検査において、ライブ像を作成するために造影剤を投与された状態での２次元Ｘ線撮影のみが必要である。マスク像は既に存在する３次元ボリュームデータから算出される。ディジタルサブトラクション血管造影法の最初の実施時には３次元ボリュームデータはまだ存在していないので、これはこの時点で作成される。一般に患者は定期的に検査されなければならないために、引続いて行なわれる他の全てのサブトラクション血管造影法に、解剖学上の背景を含んでいるこの３次元ボリュームデータを利用することができる。この場合にも、本発明による方法は長期的に見て、すなわち多数のこの種の検査の後において、患者への線量低減をもたらす。   Therefore, according to the method according to the present invention, a state in which a contrast agent is administered to generate a live image in each examination of a patient in which a blood vessel or other structure capable of administering a contrast agent is displayed by subtraction angiography. Only two-dimensional X-ray imaging is required. The mask image is calculated from the existing three-dimensional volume data. Since the three-dimensional volume data does not yet exist during the first execution of the digital subtraction angiography, it is created at this point. Since the patient generally has to be examined regularly, all subsequent subtraction angiography can utilize this three-dimensional volume data, including the anatomical background. Here too, the method according to the invention leads to a reduction in the dose to the patient in the long run, ie after a number of such examinations.

マスク像を算出する際の投影方向は自由に予め与えることができるので、ライブ像を作成するための引続いて行なわれる他の２次元Ｘ線撮影も、その都度同一投影方向で行なわれる必要はない。各２次元Ｘ線撮影の登録によって、任意の投影方向におけるあらゆるライブ像について、３次元画像データからその都度正しいマスク像を算出することができる。   Since the projection direction at the time of calculating the mask image can be freely given in advance, it is not necessary that the other two-dimensional X-ray imaging performed subsequently to create a live image be performed in the same projection direction each time. Absent. By registering each two-dimensional X-ray photography, a correct mask image can be calculated for each live image in an arbitrary projection direction from the three-dimensional image data.

以下において、図面を参照しながら実施例に基づいて再度本発明による方法を例示的に説明する。   In the following, the method according to the invention will again be illustratively described by way of example with reference to the drawings.

図１は、患者の血管を表示するための本発明による方法を実施する場合における例示的な流れ図を示す。患者から、または患者の少なくとも１つの身体範囲から、まず、３次元ボリュームデータセットが発生させられる。このデータセットの取得はＸ線コンピュータ断層撮影装置または血管撮影装置によって行なわれる。この場合に重要なことは、ボリュームデータから任意の投影方向に対する解剖学上の背景を再構成することができるように、この３次元撮影の際に血管に造影剤を投与しないことである。３次元ボリュームデータは、公知のようにして記憶され、後での継続処理のために準備される。   FIG. 1 shows an exemplary flow chart for implementing the method according to the invention for displaying the blood vessels of a patient. First, a three-dimensional volume data set is generated from the patient or from at least one body area of the patient. The acquisition of this data set is performed by an X-ray computed tomography apparatus or an angiography apparatus. What is important in this case is that no contrast agent is administered to the blood vessels during this three-dimensional imaging so that the anatomical background for any projection direction can be reconstructed from the volume data. The three-dimensional volume data is stored in a known manner and prepared for a subsequent continuation process.

本発明による方法によるサブトラクション血管造影法の実施時に、ライブ像を得るために、医師は、所望の注視もしくは投影方向で、血管が造影剤を投与されている関心身体範囲の２次元Ｘ線撮影を行なう。   When performing subtraction angiography according to the method of the present invention, in order to obtain a live image, the physician performs a two-dimensional radiograph of the area of interest in which the vessel is being administered a contrast agent in the desired gaze or projection direction. Do.

３次元ボリュームデータセットおよび２次元Ｘ線撮影はディジタル画像処理法により登録されるので、３次元ボリュームデータセットへの２次元Ｘ線撮影の正確な対応付けが可能である。３次元ボリュームデータセットがＣアーム装置の撮影に由来する場合、登録の実施が簡単になる。というのは、Ｃアームの角度を投影方向の初期評価に利用することができるからである。   Since the three-dimensional volume data set and the two-dimensional radiograph are registered by the digital image processing method, it is possible to accurately associate the two-dimensional radiograph with the three-dimensional volume data set. When the three-dimensional volume data set is derived from the imaging of the C-arm device, the registration is simplified. This is because the angle of the C-arm can be used for the initial evaluation of the projection direction.

次に、２次元撮影に一致する投影が３次元ボリュームデータセットから、造影剤を投与されない状態で解剖学上の背景のみを表示するマスク像として算出される。算出されたマスク像と撮影されたライブ像との画像データの減算は、場合によってはなおも必要なデータの対数化の後に、所望の血管撮影画像（サブトラクション画像）を供給する。   Next, a projection corresponding to the two-dimensional imaging is calculated from the three-dimensional volume data set as a mask image that displays only the anatomical background in a state where no contrast agent is administered. Subtraction of the image data between the calculated mask image and the photographed live image provides the desired angiographic image (subtraction image), possibly after the necessary logarithmization of the data.

３次元ボリュームデータセットの描画の第１ステップは、患者に対して一度だけ行なえばよい。   The first step of rendering a three-dimensional volume data set need only be performed once for a patient.

他のステップは、例えばインターベンション中に、任意に何度も自由に選択可能な投影方向から発生させられ得る。それゆえ、マスク撮影およびライブ撮影の代わりに、本発明による方法では、その都度ライブ像の作成のための２次元Ｘ線撮影のみが実施すればよい。その結果、患者へのＸ線量の低減が生じ、医師のための作業フローの最適化が生じる。   Other steps can be generated from the freely selectable projection direction any number of times, for example during an intervention. Therefore, instead of masking and live imaging, the method according to the invention only has to carry out in each case only two-dimensional X-rays for the production of live images. The result is a reduction in the x-ray dose to the patient and an optimization of the workflow for the physician.

本発明による方法の実施例を示す流れ図Flow chart showing an embodiment of the method according to the invention

Claims (3)

構造物へ造影剤を投与されない状態で作成された身体範囲の第１の２次元Ｘ線画像の画像データと、構造物へ造影剤を投与された状態で撮影された身体範囲の第２の２次元Ｘ線画像の画像データとの減算によって身体範囲の構造物の画像を形成するディジタルサブトラクション血管造影法を実施するための方法において、第１の２次元Ｘ線画像の画像データが身体範囲のコンピュータ断層撮影の３次元ボリュームデータセットから算出されることを特徴とするディジタルサブトラクション血管造影法を実施するための方法。   Image data of a first two-dimensional X-ray image of a body region created without a contrast agent being administered to a structure, and a second two-dimensional X-ray image of a body region captured with a contrast agent being administered to the structure A method for performing digital subtraction angiography in which an image of a structure of a body region is formed by subtraction from image data of a two-dimensional X-ray image, the method comprising: A method for performing digital subtraction angiography, wherein the method is calculated from a tomographic three-dimensional volume data set. コンピュータ断層撮影はＣアーム形コンピュータ断層撮影装置により行なわれることを特徴とする請求項１記載の方法。   2. The method according to claim 1, wherein the computed tomography is performed by a C-arm computed tomography apparatus. ３次元ボリュームデータセットへの第２の２次元Ｘ線画像の登録はディジタル画像処理により行なわれることを特徴とする請求項１又は２記載の方法。   3. The method according to claim 1, wherein the registration of the second two-dimensional X-ray image to the three-dimensional volume data set is performed by digital image processing.
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